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The tolerability and biochemical effects of high-dose bolus vitamin D2 and D3 supplementation in patients with vitamin D insufficiency.

Abstract

OBJECTIVES

To investigate the practicality and tolerability of high-dose intramuscular (i.m.) vitamin D2 or oral vitamin D3 replacement in vitamin D-insufficient patients, and to evaluate the biochemical efficacy of each formulation.

METHODS

Sixty-nine patients with vitamin D insufficiency [25-hydroxyvitamin D (25(OH)D) <40 nmol/L] were recruited from the Rheumatology Outpatient Department of St George's Hospital, London. In study 1, 50 patients received 300 000 IU i.m. vitamin D2 (ergocalciferol). In study 2, 19 patients received 300 000 IU oral vitamin D3 (cholecalciferol) under observation. Biochemical response was measured at baseline, and at 12 and 24 weeks.

RESULTS

Bolus i.m. vitamin D2 or oral vitamin D3 was well tolerated. The change from baseline in serum 25(OH)D was significantly greater at 6 and 12 weeks in study 2 (p<0.0001 and <0.0001, respectively). In study 1, a modest increase in mean serum 25(OH)D at 6, 12, and 24 weeks was observed but no patients achieved a serum 25(OH)D concentration > or = 50 nmol/L. PTH remained elevated in 42% of patients with secondary hyperparathyroidism at 12 weeks. In study 2, 100% and 89% of patients had serum 25(OH)D>50 nmol/L at 6 and 12 weeks, respectively. All patients with elevated baseline PTH were fully suppressed at 12 weeks. No cases of hypercalcaemia were observed in either group.

CONCLUSION

The 300 000-IU bolus of vitamin D2 or D3 was practical, well tolerated, and safe. Vitamin D3 had greater potency than equimolar vitamin D2, with a higher, sustained serum 25(OH)D response and efficacious PTH suppression. To adequately treat vitamin D insufficiency we would recommend administering 300,000 IU oral vitamin D3 approximately three times per year.

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  • Authors+Show Affiliations

    ,

    Department of Rheumatology, St George's Healthcare NHS Trust, London, UK.

    Source

    MeSH

    Administration, Oral
    Adult
    Aged
    Aged, 80 and over
    Calcifediol
    Cholecalciferol
    Ergocalciferols
    Female
    Humans
    Hyperthyroidism
    Injections, Intramuscular
    Male
    Middle Aged
    Parathyroid Hormone
    Treatment Outcome
    Vitamin D Deficiency
    Young Adult

    Pub Type(s)

    Clinical Trial
    Journal Article

    Language

    eng

    PubMed ID

    18991184

    Citation

    Leventis, P, and P D W. Kiely. "The Tolerability and Biochemical Effects of High-dose Bolus Vitamin D2 and D3 Supplementation in Patients With Vitamin D Insufficiency." Scandinavian Journal of Rheumatology, vol. 38, no. 2, 2009, pp. 149-53.
    Leventis P, Kiely PD. The tolerability and biochemical effects of high-dose bolus vitamin D2 and D3 supplementation in patients with vitamin D insufficiency. Scand J Rheumatol. 2009;38(2):149-53.
    Leventis, P., & Kiely, P. D. (2009). The tolerability and biochemical effects of high-dose bolus vitamin D2 and D3 supplementation in patients with vitamin D insufficiency. Scandinavian Journal of Rheumatology, 38(2), pp. 149-53. doi:10.1080/03009740802419081.
    Leventis P, Kiely PD. The Tolerability and Biochemical Effects of High-dose Bolus Vitamin D2 and D3 Supplementation in Patients With Vitamin D Insufficiency. Scand J Rheumatol. 2009;38(2):149-53. PubMed PMID: 18991184.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The tolerability and biochemical effects of high-dose bolus vitamin D2 and D3 supplementation in patients with vitamin D insufficiency. AU - Leventis,P, AU - Kiely,P D W, PY - 2008/11/11/pubmed PY - 2009/3/27/medline PY - 2008/11/11/entrez SP - 149 EP - 53 JF - Scandinavian journal of rheumatology JO - Scand. J. Rheumatol. VL - 38 IS - 2 N2 - OBJECTIVES: To investigate the practicality and tolerability of high-dose intramuscular (i.m.) vitamin D2 or oral vitamin D3 replacement in vitamin D-insufficient patients, and to evaluate the biochemical efficacy of each formulation. METHODS: Sixty-nine patients with vitamin D insufficiency [25-hydroxyvitamin D (25(OH)D) <40 nmol/L] were recruited from the Rheumatology Outpatient Department of St George's Hospital, London. In study 1, 50 patients received 300 000 IU i.m. vitamin D2 (ergocalciferol). In study 2, 19 patients received 300 000 IU oral vitamin D3 (cholecalciferol) under observation. Biochemical response was measured at baseline, and at 12 and 24 weeks. RESULTS: Bolus i.m. vitamin D2 or oral vitamin D3 was well tolerated. The change from baseline in serum 25(OH)D was significantly greater at 6 and 12 weeks in study 2 (p<0.0001 and <0.0001, respectively). In study 1, a modest increase in mean serum 25(OH)D at 6, 12, and 24 weeks was observed but no patients achieved a serum 25(OH)D concentration > or = 50 nmol/L. PTH remained elevated in 42% of patients with secondary hyperparathyroidism at 12 weeks. In study 2, 100% and 89% of patients had serum 25(OH)D>50 nmol/L at 6 and 12 weeks, respectively. All patients with elevated baseline PTH were fully suppressed at 12 weeks. No cases of hypercalcaemia were observed in either group. CONCLUSION: The 300 000-IU bolus of vitamin D2 or D3 was practical, well tolerated, and safe. Vitamin D3 had greater potency than equimolar vitamin D2, with a higher, sustained serum 25(OH)D response and efficacious PTH suppression. To adequately treat vitamin D insufficiency we would recommend administering 300,000 IU oral vitamin D3 approximately three times per year. SN - 1502-7732 UR - https://www.unboundmedicine.com/medline/citation/18991184/The_tolerability_and_biochemical_effects_of_high_dose_bolus_vitamin_D2_and_D3_supplementation_in_patients_with_vitamin_D_insufficiency_ L2 - http://www.tandfonline.com/doi/full/10.1080/03009740802419081 DB - PRIME DP - Unbound Medicine ER -